MAISHA Quality of Maternal and Newborn Care Study Brief, 2010–2012

The study focused on immediate essential newborn care and resuscitation, with the goal of reducing newborn mortality. Every year, more than a million newborns die on their first day of life worldwide, with birth asphyxia being a leading cause of death. In Tanzania, newborn deaths account for approximately 40% of all under-five mortality, with birth asphyxia causing an estimated 23% of newborn deaths. Studies have shown that essential care at birth and throughout the postpartum period can save up to two-thirds of these newborns. The MAISHA program, led by Jhpiego and funded by USAID, works with the Ministry of Health and Social Welfare to improve the quality of maternal and newborn care in Tanzania. Since 2008, the program has trained health care providers in basic emergency obstetric and newborn care (BEmONC), promoted supportive supervision, and facilitated quality improvement for maternal and newborn health. The QoC study used a standardized methodology and sampling approach in 2010 and 2012, combining observations of women in the maternity ward during labor and delivery, observations of antenatal care consultations, inventories and record reviews, and health worker knowledge assessments. The study found that essential newborn care was a priority in the facilities supported by the MAISHA program, with high achievement in cord care and wrapping and drying of the infant. The study also found that the areas that showed the most improvement were placing the newborn on the mother's abdomen immediately after birth to dry/stimulate and warm the baby (35% increase overall) and helping to initiate breastfeeding (42% increase overall). Universal adherence to cord cutting with a clean blade was seen in both 2010 and 2012, with delayed cord clamping increasing over the two years. Newborn resuscitation skills assessments were conducted using a newborn training model, with providers demonstrating how to conduct a newborn resuscitation while an observer used a checklist to assess their performance. The study found that skills assessments scores for newborn resuscitation were low, with only one-third of the providers able to correctly perform the stimulation and ventilation steps using the model at endline. Observations of actual newborn resuscitation were infrequent, but the number of cases observed in 2012 was higher than in 2010. The study's findings suggest that the MAISHA program has made significant progress in improving the quality of maternal and newborn care in facilities supported by the program. However, there is still room for improvement, particularly in newborn resuscitation skills. The study's results can inform the development of targeted interventions to improve the quality of care for newborns in Tanzania.